Wikipedia Falls: Post-SSRI Sexual Dysfunction

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February 12, 2014 | 8 Comments

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  1. As a clinician who prescribes SSRIs liberally and successfully for depression and occasionally specifically for premature ejaculation I find this debate fascinating – and I have an absolute admiration for voluntary moderators and contributors to wikipedia such as #98. Wikipedia is a profound tool which must be kept in check. IMHO

  2. Post-SSRI Sexual Dysfunction, or whatever one wants to call it, is as real as gravity. It’s plain stupidity to argue otherwise. It’s time to get the information for the masses. Too many lives have been lost to this sexual adverse reaction.

  3. I’d like to thank the editors of RiskRx for presenting the debate above in its entireity, and for posting the single positive comment above regarding these edits.

    The only objection that I would like to make is that I consider the comments regarding my edits to the fluoroquinolone article inaccurate and excessively partisan.

    1) My edits to the article do not simply consist of “toning down adverse events”. At the time I began editing, the article was some 4000 words long, of which only 3 sentences described what the drug was used for. Looking at the articles, which described the drugs pretty much as if they were chemical warfare agents, one was left clueless as to why they are prescribed several tens of millions of times each year. Nor was there any hint that after 20 years on the market, ciprofloxin remains one of the most effective drugs for treating life-threatening Psuedomonas infections, which are intrinsically resistant to most every other antibiotic. This imbalance was corrected both by adding efficacy data and reducing discussion of rare adverse events of unestablished causation to a summary statement.

    2) The article at the time I began editing it was far from a balanced discussion by a financially disinterested party. The majority of the article was written by the President of the Fluoroquinolone Toxicity Research Foundation, a group that self-described as existing to “support those seeking financial compensation for fluoroquinolone associated injuries”. It is likely that the editor himself was engaged in litigation against the manufacturers, though I have not been able to establish this.

    Imagine the outrage here at RiskRx were it determined that the Prozac article had been written by Eli Lilly sales reps. The situation here was no different. There was a huge financial COI that would never be acceptable to RiskRx (or to Wikipedia) if it had been on the other side of the issue. Or are financial COIs only important to RiskRx if they come from the drug industry?

    3) Comprehensively listing out every adverse event seen in even a single patient and attributed to drug treatment may well be RiskRx’s mission, but it is not Wikipedia’s. Our goal is to SUMMARIZE data about an event, person, or substance. In such an article, we do not individually list adverse events for which there are only a handful of case reports, as while deeply affecting the individuals involved, the incidence is less than one in a hundred thousand. Likewise, we do not report efficacy outcomes that are substantiated only by case reports and small clinical trials. We apply the same standards of evidence and materiality to both positive and negative drug attributes.

    The mission of Wikipedia is to provide a free encyclopedia that reports on but does not take sides in controversies, and which gives space to minority viewpoints in proportion to their prevalence among experts in the field. We do not attempt to “educate” experts, nor do we engage in advocacy. Every advocacy group in the world tries to use Wikipedia as a podium for propagating their point of view. That is not our purpose.

    Respectfully,

    Formerly_98

    • Dear Pharmaly, er, Formerly,

      Considering the value you place on evidence, it is hard to see why you would say this:

      “It is likely that the editor himself was engaged in litigation against the manufacturers, though I have not been able to establish this.”

      and then this:

      “There was a huge financial COI [Ed.: for that editor] that would never be acceptable to RiskRx.”

      Which financial COI is that?

      Regarding PSSD, I have no skin in the game. I read of the suffering, and lack of desire to live, that people report after realizing their disability is permanent. Men who cannot have sex again, and women who can’t have sex or can’t enjoy it are grieving day after day. Some of them checked wikipedia, foolishly, for information before starting on SSRIs. Reassured by the absence of correct information during certain time periods, for which you are responsible, they felt it safe to proceed.

      It’s a good thing they don’t know why the site was wrong, isn’t it?

  4. I know PSSD is real. My friends who have taken SSRI’s know it is real. It is a very prevalent side effect and covered up due to the financial implications. Saying otherwise is insulting and very suspicious.

  5. Before I took any SSRI’s I read the article on SSRI’s on Wikipedia. The article says “Sexual dysfunction occasionally persists after discontinuing SSRIs.” Had there been an article dedicated to PSSD it’s quite possible I never would have taken these drugs.

  6. The suggestion that it is only a minority that experience this side effect should be viewed in the light of the many published papers and perhaps even the yahoo support group that numbers a massive following.
    I am very suspicious of the individual who wishes to take this page down. It may not be perfect but it maybe the first point of contact for fellow sufferers.
    Any link to SSRI manufacturers in any way?
    If it is a more widespread issue, I wonder how many people would refuse it in the first place!

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